The Arris and Gale lectures on the physiological factors involved in the causation of dropsy : delivered before the Royal College of Surgeons of England on February 17th, 19th, and 21st, 1896 / by Ernest H. Starling.

  • Starling, Ernest Henry, 1866-1927.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The Arris and Gale lectures on the physiological factors involved in the causation of dropsy : delivered before the Royal College of Surgeons of England on February 17th, 19th, and 21st, 1896 / by Ernest H. Starling. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    through the impermeable limb capillaries contains only from 2 to 3 per cent, proteids. That from the intestines contains from 4 to 6 per cent, proteids, while that from the permeable capillaries of the liver contains from 6 to 8 per cent, proteids—in fact, almost as much as the blood- plasma itself. It is conceivable that we might alter the amount of lymph produced in any organ by changing, not the intracapillary pressure, but the filtering membrane—i.e., the endothelial wall of the capillaries. Such a change can be brought about in the body by various means. A whole group of bodies has been described by Heidenhain as his first class of lymphagogues. These substances, which are mostly of the nature of albumoses, can be extracted from various of the lower animals and include leech extract, mussel extract, crayfish extract, and commercial peptone. On injecting a small amount of any of these extracts into the bloodvessels of an animal the lymph from the thoracic duct is much increased in quantity and becomes more concen- trated. Now all these bodies are poisons ; they alter the blood, diminishing its coagulability, and when given in sufficiently large doses cause a great fall of blood pressure in consequence of paralysis of the heart and vessels. I have shown that the changes in the circulation produced by these bodies are insufficient to account for the increased lymph- flow, but that the increased flow is due to an alteration of the capillary walls in the abdominal organs, especially in the liver. The hepatic capillaries become even more permeable than before, so that a pressure within them which is little above normal is sufficient to cause a great increase of trans- udation through them. Another substance which seems to act directly on the capillary wall is curare. This body, however, differs from the class of lymphagogues just mentioned in the fact that its chief action is on the vessels of the limbs. The effect of curare in increasing the lymph-production in the limbs was noticed long ago by Paschutin working in Ludwig’s labora- tory. Its direct action on the endothelial wall of the capillaries can be easily demonstrated in the living frog's web. It may be seen that after the injection of curare the capillary walls become apparently more sticky, so that the capillaries become filled with a number of leucocytes adher- ing to their walls. A still more potent method of altering the permeability of the limb capillaries is to plunge the limb into water at 56° C. for some minutes. If a cannula has been previously placed in one of the main lymphatics of the leg it will be noticed that, in a very short time after this scalding, lymph begins to drop spontaneously from the cannula. The lymph which is thus produced is much richer in proteids than is lymph from a normal leg. The amount of lymph flowing from the leg can now be varied within wide limits by altering the pressure in the capillaries either by ligature of the vein or artery, injection of salt solution, or production of vaso-motor paralysis. By this scalding, in fact, we may reduce the limb capillaries to the condition of liver capillaries.